We had an extreme case roll in yesterday. A patient with a history of Chronic Mylogenous Leukemia (in remission I guess) had a bowel resection performed at the end of November. She presented yesterday with a hemoglobin of 2.6 g/dL!! Was feeling a bit run down, but was still holding a conversation with the ED staff. Today she is up to a 9.8 and feeling better (I would imagine so!!). The hematology supervisor said it was the lowest he had seen in his 35 year career. We checked and the draw site was not anywhere near an IV. How low have you seen and the patient pulled through the situation? Mostly a curiosity question.

Had a JW patient once with a PPH who went down to about the same level as your patient. Had a TAH with no blood cover and pulled through. Made me wonder why the heck I was ever employed!!!!!!!!!!

Had an old lady one time who was "just a little tired walking up the hill." Hgb 2.2. Got 4 rbcs over 3 days and went home rejuvenated.

Mine was the same as David's. I wonder if she was the same lady?? Said she was a little dizzy when she climbed a flight a stairs. The real question is, how long did it take her to get to that level. Obviously it was not a sudden drop!

Back in the days when med techs actually drew blood, we were called to the ER to help with a combative patient. She was an old lady (old to the 23 year-old Phil), but pretty big and strong as a bull. It took four of us, one on each thrashing extremity, to hold her down and get the blood drawn. Her hemoglobin was 2.0. I'd have hated to tangle with her when it got back up to double figures.

Must be the season. We had one that low a couple of days ago.

I'd have hated to tangle with her when it got back up to double figures.

Coward!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:rofl::rofl:

P.S. So would I!!!!!!!!

I think our all time record is 2.4 Hgb. We've seen a fair number of 2-4 range Hgbs over the last few years - all did well with a little top off. Makes a big difference whether they are a slow leak or a trauma with sudden dramatic loss. The slow leakers usually do pretty well. It's amazing that most of them are still functional, though complaining of feeling a little off (Ya think?!). I have read that it is not uncommon in some African countries to NOT transfuse malaria patients until the Hgb is 2-3, because the transfusion itself is so risky due to inability to test donors for HIV.

Coward!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

My sister-in-law had been trained as a cytotechnologist but her employer apparently wanted to expand her horizons and trained her to do phlebotomy as well. On her first solo trip up on the floors, her first patient died while she had the needle in his arm. She got some help, and reassurance, took a deep breath and went into the next room. As she was putting on the tournequet, the patient rolled over and punched her in the jaw. She flew backwards and smacked her head on a radiator, knocking her out. That was it for her phlebotomy career!

We had a 1.6 that survived. JW patient that had a femoral bleed and refused all blood products, including cell saver during his vascular surgery, and subsequent amputation. He was discharged with a 10 Hgb a couple weeks later with no blood transfusions. It was quite awesome and taught us a lot on how to treat traumas that refuse blood. He was a young healthy 30 year old, so he had that going for him. They kept him vented and paralyzed, gave him tons of IV iron and Procrit, and did no blood draws for an entire week.

Coward!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

My sister-in-law had been trained as a cytotechnologist but her employer apparently wanted to expand her horizons and trained her to do phlebotomy as well. On her first solo trip up on the floors, her first patient died while she had the needle in his arm. She got some help, and reassurance, took a deep breath and went into the next room. As she was putting on the tournequet, the patient rolled over and punched her in the jaw. She flew backwards and smacked her head on a radiator, knocking her out. That was it for her phlebotomy career!

The first one would have done for me Phil - FOREVER!!!!!!!!!!!!!

I think my first patient only wished he had died. I never had one actually do so, although I did try to wake up, with great lack of success, a few of them who had expired.

We had a woman who was 2.6 g/dl. She drove her husband to the doctor's office for his appointment, but she was the one who ended up in the hospital. Can you believe she was driving?

I think my first patient only wished he had died. I never had one actually do so, although I did try to wake up, with great lack of success, a few of them who had expired.

I've done that, too. Actually drew one poor soul who had expired already (he was still warm, though) when I was young and new. I came out of the room with sample in hand and a nurse passing in the hall asked me why I had drawn the dead guy. Nice of them to let us know!

Nice of them to let us know!

They never do. You open the curtain, see the patient peacefully sleeping, say a cheery "Good morning, hon, I have to get a little blood from your arm", then give them a gentle wake-up shake and realize they're cold and stiff. And you hurry to find a nurse to let them know they've lost one and they tell you, "Oh, she's dead." No kidding. Maybe they need to reinstate the pennies on the eyes...........

Maybe they need to reinstate the pennies on the eyes...........

Oh my, there's a picture! Would be pretty effective, though.

We had a vegan with a walk-in haemaglobin of 2.4, the lowest I have seen, with recovery, in massive blood loss is 2.8.

TBOstock - that is an amazing story!

Edit - I forgot to add that this lady wasn't transfused either. She was given iron infusions and folate and within 3 months her hb was 12.5! Yes she was symptomatic, but her body had adapted so transfusion was deemed unnecessary

Edited December 22, 201113 yr by Auntie-D

I had a patient with a Hb of 2.4 in the early hours a couple of years ago, post myomectomy the previous day. The lady survived following a hysterectomy with platelet, FFP and red cell support. Blood and platelets arrived by blue light courtesy of Malcolms blood centre. Like others have said survival is often dependent on acute or chronic loss, age of patient, fitness of patient etc. In my case acute loss but patient was young.

Steve

:)

We have had a few between 2 an 3, usually iron deficiency patients. The body is quite good at adapting to chronic anemia.

Since I never win any contests I have to jump in here - this may be my day. A few months ago we had a patient in the ED with a migraine headache. This 45 kg (99 lb.) female had a hgb of 0.3, RBC 0.23. We called for a redraw of course, with the same results (and chemistry results from the same draw were relatively normal). The patient was not actively bleeding, was walking and talking. She said she had had chronic anemia all her life and had the red cell indices to support this. Five units of packed cells later, she left with a 10.4 hemoglobin.

OK that is truely incredible!! The human body is amazing.

How old was she, and how was her cardiac function after the shock of her Hb going up 10.1g/dL in such a short space of time?????

Cardiac function was part of my concern with our recent case. She has had no negative outcome to my knowledge and the units were all administered within a 24 hour period.

Since I never win any contests I have to jump in here - this may be my day. A few months ago we had a patient in the ED with a migraine headache. This 45 kg (99 lb.) female had a hgb of 0.3, RBC 0.23.

You are definitely the hands-down winner here - Wow! Must not have been much of a cell button when you spun down the chemistry tubes.

Here's a question for all... Chronic anaemia in a walking well patient - why transfuse? Their bodies have adapted... If there is no medical reason a Hb can be returned to 'normal' in about 3 months with iron infusions and/or folate/b12. Our lady with the Hb of 2.4 wasn't transfused and recovered perfectly well with just iron infusions and folate supplements. How can donor exposure be justified, based on numbers alone, if the patient is clinically well?